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Accumulator - View By Claim

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Health Center:
Pharmacy:
Capture Date :
To:


Health
Center
Pharmacy
ShipTo
Claim
Type
RX
Number
Member ID
Fill
Fill Date
Adjud
Date
Captured
Date
NDC
Drug
Name
Strength
Form
Pkg
Size
QTY
Disp
Curr
QTY
% of
Claim
Status
Status
Date
Order
Wholesaler
Invoice
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410402/04/202102/04/202102/06/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793015 MR002603410103/13/202303/13/202303/14/202300527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90903943.33300Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794904 MR000374450304/06/202304/06/202304/07/202300527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797764 MR000374450005/04/202305/04/202305/05/202300527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90301550.00000Replenished05/05/2023 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410503/08/202103/08/202103/09/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776536 MR001943700502/19/202102/19/202102/20/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90302480.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777779 MR001652240403/09/202103/09/202103/10/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780208 MR002044000002/26/202102/26/202102/28/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774134 MR000374450803/29/202103/29/202103/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90301550.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776536 MR001943700603/24/202103/24/202103/25/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001834470 3051403572